Showing papers by "Pramod Kumar Garg published in 2011"

Diagnosis and management of acute variceal bleeding: Asian Pacific Association for Study of the Liver recommendations

Abstract: Acute variceal bleeding (AVB) is a medical emergency and associated with a mortality of 20% at 6 weeks. Significant advances have occurred in the recent past and hence there is a need to update the existing consensus guidelines. There is also a need to include the literature from the Eastern and Asian countries where majority of patients with portal hypertension (PHT) live. The expert working party, predominantly from the Asia–Pacific region, reviewed the existing literature and deliberated to develop consensus guidelines. The working party adopted the Oxford system for developing an evidence-based approach. Only those statements that were unanimously approved by the experts were accepted. AVB is defined as a bleed in a known or suspected case of PHT, with the presence of hematemesis within 24 h of presentation, and/or ongoing melena, with last melanic stool within last 24 h. The time frame for the AVB episode is 48 h. AVB is further classified as active or inactive at the time of endoscopy. Combination therapy with vasoactive drugs (<30 min of hospitalization) and endoscopic variceal ligation (door to scope time <6 h) is accepted as first-line therapy. Rebleeding (48 h of T 0) is further sub-classified as very early rebleeding (48 to 120 h from T 0), early rebleeding (6 to 42 days from T 0) and late rebleeding (after 42 days from T 0) to maintain uniformity in clinical trials. Emphasis should be to evaluate the role of adjusted blood requirement index (ABRI), assessment of associated comorbid conditions and poor predictors of non-response to combination therapy, and proposed APASL (Asian Pacific Association for Study of the Liver) Severity Score in assessing these patients. Role of hepatic venous pressure gradient in AVB is considered useful. Antibiotic (cephalosporins) prophylaxis is recommended and search for acute ischemic hepatic injury should be done. New guidelines have been developed for management of variceal bleed in patients with non-cirrhotic PHT and variceal bleed in pediatric patients. Management of acute variceal bleeding in Asia–Pacific region needs special attention for uniformity of treatment and future clinical trials.

Role of (68)Ga-DOTATOC PET-CT in the diagnosis and staging of pancreatic neuroendocrine tumours.

Abstract: Objective The objective of the present study was to evaluate the role of 68Ga-DOTA(0)-Phe(1)-Tyr(3)-octreotide (68Ga-DOTATOC) positron emission tomography computed tomography (PET-CT) for detection and staging of pancreatic neuroendocrine tumours (NETs).

Oxidative stress in chronic pancreatitis: pathophysiological relevance and management.

Abstract: Significance: Chronic pancreatitis (CP) is a progressive, inflammatory disease of the pancreas leading to slow destruction of pancreatic parenchyma and progressive fibrosis. The pathophysiological mechanism of CP is not well understood. Recent Advances: A pathophysiologic role of oxidative stress in CP has, however, been suggested in recent years. Pancreatic acinar cells contain phase I cytochrome P450 (CYP 450) biotransforming enzymes and phase II conjugation reactions for the metabolism of xenobiotics. The oxidative stress in the acinar cell may result from generation of free radicals through CYP induction, concurrent exposure to a chemical that undergoes bioactivation, and insufficiency of micronutrients that are required to sustain antioxidant (AO) capacity. Critical Issues: Studies have shown that there is indeed a state of oxidative stress as evidenced by increased levels of products of oxidative stress and reduced AO capacity in patients with CP. A recent randomized, controlled trial has s...

A randomized controlled trial of valdecoxib and glyceryl trinitrate for the prevention of post-ERCP pancreatitis.

Abstract: BackgroundEfforts to prevent post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis have been largely unsuccessful. Cyclo-oxygenase-2 enzyme-mediated inflammatory pathway has been suggested in the pathophysiology of acute pancreatitis. Glyceryl trinitrate (GTN) might prevent post-ER

Endovascular management in abdominal visceral arterial aneurysms: A pictorial essay

Abstract: Visceral artery aneurysms (VAAs) include aneurysms of the splanchnic circulation and those of the renal artery. Their diagnosis is clinically important because of the associated high mortality and potential complications. Splenic, superior mesenteric, gastroduodenal, hepatic and renal arteries are some of the common arteries affected by VAAs. Though surgical resection and anastomosis still remains the treatment of choice in some of the cases, especially cases involving the proximal arteries, increasingly endovascular treatment is being used for more distal vessels. We present a pictorial review of various intra-abdominal VAAs and their endovascular management.

Schwannoma of the ascending colon with ileocolic intussusception

Abstract: even a pancreaticoduodenectomy has been performed mistaking it to be a cystic neoplasm of pancreas. In our case also pre-operative and intra-operative diagnosis was of a cystic neoplasm of head of pancreas. Our patient underwent a pancreatodeudonectomy. Adjuvant medical therapy is reserved for patients where complete surgical excision is not possible or patients unfit for surgery. In conclusion, primary hydatid disease of pancreas is extremely rare. However, a high degree of clinical suspicion should be kept whenever dealing with cystic lesions of pancreas especially in endemic areas as it is very difficult to arrive at a diagnosis pre-operatively.